Scars are visible signs that remain after a wound has healed, being the inevitable result of injury or surgery, and their development can be unpredictable. Poor healing can contribute to the appearance of unfavorable scars. Even a wound that heals well can result in poor scarring in appearance.

Your treatment options vary according to the type and degree of scarring and may include:
• Simple topical treatments;
• Minimally invasive procedures;
• Surgical revision with advanced wound closure techniques.

Scar correction surgery is designed to minimize the scar so that it is more even with your skin tone and surrounding texture. Although scar correction provides a more pleasant aesthetic result or improves a scar that is poorly healing, a scar cannot be completely erased.

Scar correction is plastic surgery performed to improve the condition or appearance of a scar anywhere on the body. The different types of scars include:

Discoloration, surface irregularities  and other more subtle scars can be aesthetically improved by surgery or other treatments recommended by the plastic surgeon. These types of scars do not impair function or cause physical discomfort and include acne scars as well as scars from minor injuries and previous surgical incisions.

Hypertrophic scars are thick clumps of scar tissue that develop directly at the site of scarring. These scars are most often raised, red and/or uncomfortable, and can become larger over time. They can be hyperpigmented (darker in color) or hypopigmented (lighter in color).

Keloids are larger than hypertrophic scars. These scars can be painful or itchy and can also wrinkle. They extend beyond the edges of an initial wound or incision and can occur anywhere on the body, but they most commonly develop where there is little underlying fatty tissue, such as the face, neck, ears, chest and on the shoulders.

Contractures are scars that restrict movement due to the skin and underlying tissue pulling together during healing. Contractures occur when there is a large amount of tissue loss, for example after a burn. Contractures can also form where the wound joins the joint, restricting movement of the fingers, elbows, knees and neck.

The type of scar you have will determine the appropriate techniques the plastic surgeon will use to smooth the scar.

Scar correction surgery is a highly individualized procedure and you should do it for yourself, not to satisfy someone else's desires or to conform to any type of ideal image.

The procedure can be performed on people of any age and is a good option for you if:
• You feel uncomfortable having a scar on any part of your body;
• You are physically healthy;
• You don't smoke;
• You have a positive outlook and realistic expectations about the procedure;
• You do not have active acne or other skin conditions in the area to be treated.

The success and safety of the surgical procedure depend on your sincerity during the consultation. You will be asked about your health, desires and lifestyle.

• The reason why you want to undergo surgery, your expectations and the desired result;
• Medical conditions, previous drug allergies and previous medical treatments;
• Current use of medications, vitamins, natural medicines, tobacco, alcohol and drugs;
• Previous surgeries.

• Assess your general health status and any pre-existing health conditions or risk factors;
• Take photos for medical records;
• Discuss your options and recommend treatment;
• Discuss likely results of surgery and any potential risks or complications .

The decision to undergo surgery is a personal one and it is up to you to decide whether the benefits will meet your goals and whether the potential risks and complications of surgery are acceptable. The plastic surgeon and/or assistants will explain, in detail, the risks associated with the surgery. You will be asked to sign the consent form to ensure that you fully understand the procedure you will undergo and any potential risks or complications.

• Bleeding (bruise);
• Accumulation of fluid (seroma);
• Infection;
• Anesthetic risks;
• Poor healing;
• Skin necrosis;
• Numbness or other changes in skin sensitivity;
• Asymmetry;
• Skin depigmentation and/or prolonged swelling;
• Adipose tissue necrosis;
• Damage to deeper structures such as nerves, blood vessels, muscles and lungs;
• Pain, which may last;
• Deep vein thrombosis, cardiac and pulmonary complications;
• Suture threads may spontaneously emerge from the skin, becoming visible or causing irritation that requires their removal;
• Possibility of a new surgical procedure.

It is important that you ask all your questions directly to the plastic surgeon.
It is natural to feel a little anxiety, whether it is anticipation of the result or pre-operative stress. Discuss these feelings with your plastic surgeon.

The procedure must be carried out in a safe and comfortable place for the doctor and the patient, in a surgical center authorized by the Health Surveillance, with equipment and trained staff for any complications.

At the end of the procedure, bandages or dressings may be applied to the surgical site to keep it clean.

How to care for the surgery site, medications to apply and take orally to help with healing and reduce the risk of infection, specific care for the surgery site and your general health, and post-operative follow-up with the plastic surgeon.

If you experience shortness of breath, chest pain, or an abnormal heartbeat, seek medical attention immediately. If any of these complications occur, you may need hospitalization and additional treatment.

Following your doctor's recommendations is essential for the success of the surgery. It is important that surgical incisions are not subject to excessive force, swelling, abrasion, or movement during the healing period and avoid exposure to the sun.

Before surgery, it may be necessary to:
• Take laboratory tests or medical evaluation;
• Taking certain medications or adjusting your current medications;
• Stop smoking well before surgery;
• Avoid taking aspirin, anti-inflammatories and natural medicines, as they can increase bleeding.

• What to do the night before and the morning of surgery (fasting time, medications, bath);
• Information about the type of anesthesia to be performed;
• Guidance on post-operative care.

Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. Options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.

Step 2 – Treatment
The degree of improvement that can be obtained with scar correction will depend on the severity, type, size and location of the scar. In some cases, a single technique can provide significant improvement. However, your plastic surgeon may recommend a combination of correction techniques to achieve the best results.

Topical treatments such as gels, tapes or external compression can help wounds close and heal or decrease the skin's ability to produce uneven pigment. These products can be used to treat existing superficial scars and discoloration, and to aid in the healing of scar correction procedures.

Injectable treatments are often used to fill reduced scars. Depending on the injectable substance used and the condition of the scar, results can last from three months to several years. Therapy must be repeated to maintain results. One form of injection therapy uses steroid-based compounds to reduce collagen formation and can change the appearance, size, and texture of scar tissue.

Surface treatments are most often used to improve scar aesthetics. These methods can smooth surface irregularities and reduce uneven pigmentation. Surface treatments are a controlled means of mechanically removing the top layers of skin or altering the nature of the tissue. These treatment options include:

• Dermabrasion: Helps refine the surface layers of the skin through a controlled method of surgical scraping.
• Laser or light therapy: Causes changes to the surface of the skin, allowing new, healthy skin to form at the site of the scar.
• Chemical peeling solutions: Penetrate the skin's surface to smooth irregularities in texture and color.
• Skin bleaching agents: Medications applied topically to lighten the skin.

Step 3
Sometimes, for deeper scars, multiple incisions may be needed to surgically remove the scar.

Step 4 – Closing the incisions
Some scars require layered closure. Layered closure is often used where the incision extends into the tissue, below the surface of the skin, or in areas with a high degree of movement. The first stage, or layer, requires subcutaneous closure (below the surface of the skin) with absorbable or non-removable sutures. Advanced scar correction techniques include flap closure to reposition a scar so that it is less visible, or to improve flexibility where contracture restricts movement.

Pharmaceutical tissue substitutes may be used if healthy tissue is not present to close a scar excision, most likely with the correction of severe burn scars.

Tissue expansion can be a replacement procedure for skin grafts. In this procedure, an inflatable balloon, called a tissue expander, is placed under the skin near the scar site. Over time, the balloon is slowly filled with sterile solution to expand the area of ​​healthy skin. Once the skin has been sufficiently stretched, the expander and scar are removed and the stretched skin is moved to replace the scar tissue. This process may involve several steps or surgical procedures in order to achieve the final results.

The initial healing phase may include localized swelling, discoloration, or discomfort and may take 1 to 2 weeks. Healing will continue for several weeks. With dermabrasion, chemical peeling , or laser resurfacing, the conditions in the treated areas will be the same, in addition to general sensitivity.

The final results of scar correction surgery may take several months to become apparent, and in some cases, it may take a year for the new scar to completely heal.

The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure, requiring further surgery.

Cost is always a consideration in elective procedures. Prices can vary greatly, depending on the procedure to be performed and the professional's experience.

• Surgeon's fees;
• Hospital or surgical center expenses;
• Anesthetist's fees;
• Medical exams.

When choosing a plastic surgeon to perform the procedure, remember that the surgeon's experience and your good relationship with him or her are as important as the final cost of the surgery.

• Chemical peeling solution: Substances that penetrate the skin's surface to smooth irregularities in texture and color.
• Contractures: Scars that restrict movement due to the skin and underlying tissue pulling together during healing, typically occurring when there is a large amount of tissue loss, such as after a burn.
• Dermabrasion: Mechanical removal of the skin.
• Excision: Surgical removal of a scar.
• General anesthesia: Drugs and gases used during surgery to relieve pain and decrease consciousness.
• Hyperpigmented scars: Darker colored scars.
• Hypertrophic scar: Thick clusters of scar tissue that develop directly at the site of scarring.
• Hypopigmented scar: Lighter colored scar.
• Intravenous sedation: Sedatives given by injection into a vein to help you relax.
• Keloids: Large scars that can cause pain or itching.
• Laser resurfacing: Method of altering the surface of the skin, allowing new, healthy skin to form at the site of the scar.
• Local anesthesia: Drug injected directly into the incision site during surgery to relieve pain.
• Skin grafts: Healthy skin is taken from other areas of the body, such as the abdomen or thigh, to correct a scar.
• Tissue expansion: Procedure that can replace skin grafts. An inflatable balloon, called a tissue expander, is placed under the skin, near the scar site, to stretch additional skin and be used to correct the scar. Often multiple procedures are required.
• Zetaplasty: Surgical technique that creates inclined flaps on both sides of the original scar site, which can reposition or completely change the direction of the scar, interrupt tension or improve the flexibility of the scar.

Use this list as a guide during your consultation:
• Are you a specialist by the Brazilian Society of Plastic Surgery?
• Have you been trained specifically in the field of plastic surgery?
• Is the installation of the surgical center in your office authorized by the Health Surveillance?
• How many procedures of this type have you performed?
• Am I a good candidate for this procedure?
• What is expected of me so that the best results are obtained?
• Where and how will the procedure be performed?
• What is the recovery time and what kind of help will I need during my recovery?
• What are the risks and complications associated with this procedure?
• How are complications treated?
• What are my options if I am unhappy with the outcome of my surgery?